Endovascular treatment of a bilateral dural carotid-cavernous fistula using an unusual unilateral approach through the basilar plexus.

Abstract

Indirect carotid-cavernous fistulae are dural arteriovenous shunts between dural branches of the internal and/or external carotid arteries and the cavernous sinuses. We present an uncommon case of bilateral dural carotid-cavernous fistula with aggressive angioarchitectural features that was successfully treated with bilateral coil embolization using an unusual unilateral transvenous approach through the basilar plexus. This route should be considered for similar cases, and also for unilateral fistulae when the ipsilateral petrosal sinus cannot be accessed.